So Is The Placebo Effect Magical Thinking Or Real?

A quest to deconstruct the placebo effect leads New Yorker writer Michael Spector to Cambridge, to the Harvard office of Ted Kaptchuk, a trained acupuncturist who directs the Program in Placebo Studies and the Therapeutic Encounter at Beth Israel Deaconess Medical Center.

In profiling Kaptchuk, a former 60s radical now battling the medical establishment, the piece seeks to determine how placebos can be deployed to actually care for patients — if at all. (Telling Kaptchuk quote: “What do I really want? Anything that gets people off the conveyor belts that move from the pharmaceutical houses to doctors and on to patients is worth considering. Anything. We need to stop pretending it’s all about molecular biology.”)

Oddly, the article offers a kind of on-the-one-hand-on-the-other-hand treatment of the issue. Yes, there have been some promising studies examining placebos in the context of certain types of symptoms and illnesses (pain and Irritable Bowel Syndrome, for instance). But other studies show little or no benefit.

This summer, Kaptchuk was involved in a study of asthmatics that found while placebos had no impact on chemical markers, patients reported feeling better even when given fake medications. The takeaway on that study, which we wrote about here, “is that there’s something therapeutic about the act of treatment itself, the ritual of care and the reassuring bond between doctor and patient that makes people feel better, whether or not their treatment includes pills or drugs with an active ingredient.”

As Kaptchuk told me a few months ago: The placebo effect “isn’t just about the sugar pill, it’s the context in which it’s embedded. For patient-centered outcomes, just caring for people and giving treatment carries a significant punch for relieving illness and reducing complaints.”

So what’s a patient to think?

In the end, Spector seems to agree it’s not about the sugar pill, but about the care. He describes his own experience of chest pains, relieved, as it turns out by a reassuring visit to a trusted doctor. “…that afternoon,” Spector writes, “we engaged in exactly the type of ritual that, according to Kaptchuk, will have to play a critical role in the future of American health care. And, at least in this instance, it would have been hard to argue that it didn’t work.”

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Massachusetts is the leading laboratory for health care reform in the nation, and a hub of medical innovation. From the lab to your doctor’s office, from the broad political stage to the numbers on your scale, we’d like CommonHealth to be your go-to source for news, conversation and smart analysis. Your hosts are Carey Goldberg, former Boston bureau chief of The New York Times, and Rachel Zimmerman, former health and medicine reporter for The Wall Street Journal.

If they’re so effective, why aren’t more women using IUDs and implants? A health clinic in Worcester is getting help to put better birth control front and center — particularly long-acting birth control, in hopes of cutting the high rate of unintended pregnancy.